Preventative Work & Promotion of Psychological Wellbeing

in Clinical Psychology

Shona BrownFleur-Michelle Coiffait

Gráinne O’BrienLouise Roach

Trainee Clinical PsychologistsUniversity of Edinburgh

Monday, 14 May 2012

Preventative Approach

• “…interventions that anticipate a disorder, or promote optimal health prior to the onset of a disorder (Goldston, 1977).

• Physical health – immunizations, obesity

Monday, 14 May 2012

Why useful in mental health?

• 450 million people alive today suffer mental health disorders (WHO, 2001)

• Personal impact

• Economic implications (Layard Report, 2005) – Focuses on individual level

Monday, 14 May 2012

Focus of interventions

• Why don’t individuals seek help?– Stigma– Failure to identify symptoms– Unaware of local resources

Targeted by prevention of mental health problems and promotion of mental health wellbeing.

Monday, 14 May 2012

Types of Prevention Programmes

• Universal• Selective• Indicated

Monday, 14 May 2012

Prevention Programmes

• Depression in adults – prevention of development of moderate depressive episodes and reduction in symptoms of anxiety and depression

(Seligman et al., 1999; Munoz et al., 1995)

Monday, 14 May 2012

Prevention Programmes

• Depression in children – reduction in depressive episodes and symptoms of depression

(Clarke et al., 1995; Jaycox et al., 1994)

• Substance misuse, anxiety, suicide...

Monday, 14 May 2012

Recommendations for Prevention Programmes

• In order to be most effective, a screening process should be used. Focus on participants especially at risk

• CBT is a popular model on which to base a programme

• Group programmes are common, but individual approaches are also possible

Monday, 14 May 2012

Prevention Programmes?Early BirdThe NAS EarlyBird Programme is autism-

specific and has three content 'threads'. It helps parents to:

• understand their child's autism • structure interactions in which

communication can develop • pre-empt problem behaviours and handle

those that occur.

Monday, 14 May 2012

Prevention Programmes?

Mellow Parenting / Mellow Babies• Aims to support parents with relationship

problems with their infants and young children

• Combines personal support for parents with video and direct work with parents and children addressing parenting problems

Monday, 14 May 2012

Prevention Programmes?

The Solihull Approach• Integrated model of working• Resource packs and training for care

professionals• Focuses on containment, reciprocity, and

behaviour management• Research suggests 66% reduction of

parental anxiety

Monday, 14 May 2012

‘Mental capital’ over the course of life

Beddington et al. (2008)

Monday, 14 May 2012

Early Intervention in Childhood

• Maximising protective factors: proactive approach to mental health and wellbeing

• Minimising effect of threats to mental wellbeing: early intervention

Monday, 14 May 2012

Pyramid Clubs

• Screening of children at risk: Strengths and Difficulties Questionnaire

(SDQ; Goodman, 1989)• Multi-agency meeting to select 10 children• 10 week activity club hosted by schools• Trained volunteers provided by National

Pyramid Trust (charity) run the clubs

Monday, 14 May 2012

Pyramid Clubs

• SDQ completed as follow-up measure • Rich data set (pre- and post- activity club)

but little published research• Children with and without difficulties

appear to benefit from attending. • Significantly larger effect size for children

with identified difficulties (Ohl et al., 2008)

Monday, 14 May 2012

Nurture Groups

• For primary school children with social, emotional or behavioural difficulties (as measured using Boxall Profiles)

• Small ‘nurturing’ class with increased staff ratio

• Taught social skills and practical skills as well as curriculum based work

• Routines, explanations in context

Monday, 14 May 2012

Examples with Adults

• Role for CPs in training, consultancy and research at multiple levels. Some examples:

- media e.g. BBC’s “Headroom” - specific programmes e.g. Positive Mental

Attitudes Workplace Intervention in Glasgow

Monday, 14 May 2012

Media

• May 2008 BBC launched 2 year “Headroom” campaign

• Includes on air programming, outdoor events and interactive website

• Aim “to actively encourage people to assess their mental wellbeing and take simple, practical steps to manage or improve it”

Monday, 14 May 2012

Media

• Peter Kinderman (Professor of Clinical Psychology at the University of Liverpool) developed “Mind Spa” component of website

• Participants complete online assessments of their mental wellbeing and receive offer of personal life coach to explore results and develop plan with goals for the future

Monday, 14 May 2012

Media• Benefits = BBC so reaching large

audience, multifaceted “intervention”, increasing knowledge?, reducing stigma? (need for well conducted research)

• But.. Many similar websites (e.g. Chris Williams’ LLTTF, Mood Gym). Waste of resources? Risk that users (and possibly referrers) will feel overwhelmed with choice?

Monday, 14 May 2012

Positive Mental Attitudes (PMA) – Workplace Programme

• Visit workplaces throughout Glasgow to provide mental health awareness sessions to staff.

• Assist organisations to develop mental health and wellbeing policies

• Claim benefits to organisation (e.g. reduced staff absence and staff turnover).

• Broader aim of increasing knowledge and reducing stigma

Monday, 14 May 2012

Positive Mental Attitudes (PMA) – Workplace Programme

Aim for participants to leave with increasedunderstanding of:• Mental health, mental health problems

and their causes• How to maintain their own mental health

and that of those around them• Mental health and wellbeing resources

Monday, 14 May 2012

Positive Mental Attitudes (PMA) – Workplace Programme

• PMA run other projects (Later Life, School based, Asylum Seekers and contribute to Scottish Mental Health and Arts Festival)

• Funding and management input from NHS • Input from CPs based in primary care

mental health team – consultancy role with regards content of programmes and research supervision

Monday, 14 May 2012

Why are psychologists best placed?

• Knowledge base - expertise in area - Increase own knowledge

• Interdisciplinary working

• Scientist Practitioner– Research, audit and evaluation

Monday, 14 May 2012

Barriers to preventative mental health practice

• Who to target?

• Is it possible within current resources of clinical psychology?

• Where responsibility lie?– ‘Bystander effect’ (Ball, 2008)

Monday, 14 May 2012

Future Directions

• Shift in paradigm needed – become more prevention focused

• Further research needed– Need to ascertain validity and effectiveness of

interventions.

• CPs well placed to contribute to this research agenda

Monday, 14 May 2012

Any questions?

Monday, 14 May 2012